Comparison of Hip Fracture Risk Between Zolpidem and Zopiclone in Older Adults

Zolpidem and zopiclone are widely prescribed hypnotics for older adults, yet their comparative safety regarding hip fracture risk remains unclear. This study aimed to compare the risk of hip fracture between zolpidem and zopiclone among adults aged 65-84 years.

Electronic health records from 166 global healthcare organizations in the TriNetX platform were analyzed. Adults aged 65-84 years who were newly prescribed zolpidem or zopiclone were identified. Propensity score matching was used to balance baseline characteristics. The TriNetX "Compare Outcomes" tool was used to estimate the cumulative incidence of hip fracture, hazard ratio, and 95% confidence interval between zolpidem users and zopiclone users.

After propensity score matching, 41,500 adults were included in each group. During the 1-year follow-up period, 100 adults in the zolpidem group and 174 adults in the zopiclone group experienced a hip fracture, corresponding to cumulative incidences of 0.24% and 0.42%, respectively. In the Cox proportional hazards regression model, zolpidem use was associated with a reduced risk of hip fracture (hazard ratio 0.51; 95% confidence interval, 0.40-0.66).

Zolpidem was associated with a lower risk of hip fracture compared with zopiclone among adults aged 65-84 years. These findings highlight the need for further research to confirm these differences and explore underlying mechanisms.